Provider Demographics
NPI:1366450363
Name:ABSOLUTE CHIROPRACTIC, PA
Entity Type:Organization
Organization Name:ABSOLUTE CHIROPRACTIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-281-9566
Mailing Address - Street 1:1610 14TH ST NW
Mailing Address - Street 2:#102
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-0229
Mailing Address - Country:US
Mailing Address - Phone:507-281-9566
Mailing Address - Fax:507-281-9570
Practice Address - Street 1:1610 14TH ST NW
Practice Address - Street 2:#102
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-0229
Practice Address - Country:US
Practice Address - Phone:507-281-9566
Practice Address - Fax:507-281-9570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4333111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty